Duplex kidney: An incidental autopsy finding of clinical and medico-legal significance.

Duplex kidney, a rare congenital anomaly characterised by dual urinary drainage from the kidney, is typically discovered incidentally, often during radiological imaging or autopsy procedures. We report a case of a 21-year-old male who died from injuries sustained in a road traffic accident. The autopsy examination showed an incidental finding of duplex kidney on the left side. We discuss the clinical and potential medico-legal significance of duplex kidney which also has implications in renal transplantation. Notably, the presence of duplex kidney can potentially serve as an identifier in forensic investigations, given its rare incidence.

Ant bite artifacts in a case of hanging.

Artifacts produced by postmortem animal scavenging are commonly encountered at autopsy. Knowledge of the pattern of artifacts produced by postmortem animal scavenging is essential for the correct interpretation of the autopsy finding. In household deaths, such artifacts are usually caused by domestic animals and by small insects such as flies, ants, beetles, etc. Ants are one of the early scavengers which feed on the dead bodies. The artifacts produced by the postmortem ant activity are usually superficial and non-bleeding type. Rarely, in the congested body regions and areas of marked hypostasis, postmortem bleeding artifacts due to ant bites are possible. In the reported case of hanging, such postmortem bleeding artifacts were present over both the legs, predominantly over the left leg. Typical ant bite lesions in the form of superficial excoriations were also present over the peri-ligature area, over and around both nipples and over the lower part of the abdomen. Morphologically, postmortem bleeding artifacts produced by ant bites exhibit four patterns: droplet pattern, stripe pattern, pool pattern, and mixed pattern. In this case, a mixed pattern (droplet pattern and stripe pattern) of postmortem bleeding artifacts was observed. The presence of postmortem bleeding artifacts over the lower limbs was attributed to the pooling of the blood due to suspension of the body, followed by passive escape of blood due to ant bites. The possibility of such artifacts produced by ant bites should be considered when the origin of the lesion is unclear.

An unusual case of high-voltage electrocution of a truck driver due to inadvertent contact of the truck with an overhead wire.

Electrocution deaths are mostly accidental. However, reconstruction of events in unusual electrocution death is challenging. This article reports an accidental death due to electrocution in a highly unusual circumstance, in which a truck driver reversing his vehicle was electrocuted when his truck inadvertently touched an overhead high-voltage wire. The electric injury marks were present over the sole of the right foot. The scene investigation revealed that the high-voltage wire was loose and was below the level of the prescribed height. The truck was passing over an elevated area made up of dirt and stone. The interior of the cabin of the truck revealed a few non-insulated metallic areas over the floor of the truck, between the accelerator and the brake, which were attributed as the sources of entry of electricity into the body. The electric injury marks were different than those usually seen in high-voltage electrocution as there was an intermediate object (truck) involved, and the contact period between the truck and the electric wire was minimal. This fatality was attributed to the non-proper insulation of the interior of the truck, the negligent driving of the truck driver over the elevated surface, and the loose high-voltage wire without proper maintenance.

Spontaneous retroperitoneal and intracranial hemorrhage following streptokinase therapy in acute myocardial infarction: An autopsy case report.

Bleeding complications following thrombolytic treatment for acute myocardial infarction (AMI) are not infrequent, among which intracranial hemorrhage is commonly reported. In contrast, retroperitoneal hematoma following the administration of thrombolytics is rarely reported in the literature. We are reporting a case of a middle-aged man, who presented with left-sided chest pain and was diagnosed with acute coronary syndrome with anterior wall ST elevation AMI. The patient was administered with thrombolytic drugs, including streptokinase and heparin. Percutaneous coronary intervention in the form of Coronary angioplasty with stent insertion was done to the left anterior descending artery, given coronary artery disease. The blood investigations showed elevated activated partial thromboplastin time and prothrombin time. The patient developed vomiting, altered sensorium, and left-sided weakness, and a non-contrast computerized tomography brain was done, which showed acute hemorrhage involving the right frontal lobe with intraventricular extension, so the ventricular drain was placed. The patient developed cardiac arrest and died on the third day. On autopsy examination, the brain showed subarachnoid hemorrhage, intraparenchymal hemorrhage over the right frontal lobe, and clotted blood in all the ventricles. A retroperitoneal hematoma of around 1500 cc was seen over the left side of the peritoneal cavity. This case highlights that although intracranial hemorrhage is a known complication after administrating thrombolytic therapy, clinicians should also be aware of the possibility of retroperitoneal hemorrhage. This case emphasizes the value of an autopsy in determining the cause of death in such situations.

ChatGPT in medical research: challenging time ahead.

Since its launch, ChatGPT, an artificial intelligence-powered language model tool, has generated significant attention in research writing. The use of ChatGPT in medical research can be a double-edged sword. ChatGPT can expedite the research writing process by assisting with hypothesis formulation, literature review, data analysis and manuscript writing. On the other hand, using ChatGPT raises concerns regarding the originality and authenticity of content, the precision and potential bias of the tool's output, and the potential legal issues associated with privacy, confidentiality and plagiarism. The article also calls for adherence to stringent citation guidelines and the development of regulations promoting the responsible application of AI. Despite the revolutionary capabilities of ChatGPT, the article highlights its inability to replicate human thought and the difficulties in maintaining the integrity and reliability of ChatGPT-enabled research, particularly in complex fields such as medicine and law. AI tools can be used as supplementary aids rather than primary sources of analysis in medical research writing.

Further explorations into the role of mast cells in deaths associated with fatal asphyxia: an immunohistochemical study utilizing CD 117 marker.

Asphyxia-related deaths have always been a challenging task in the speciality of forensic pathology. Apart from helpful macroscopical signs (e.g., strangulation mark, cyanosis, petechial haemorrhage, and lung oedema), recent literature indicates that prolonged asphyxia is sufficient to induce an increase in mast cells (MC). Inflammatory cells migrate from the bone marrow to the lungs, aiding in the diagnosis of fatal asphyxial deaths. HIF1-α, a key regulator protein, is released from lung tissue capillaries during catastrophic hypoxia circumstances, as previously demonstrated in immunohistochemistry (IHC) research. The present study analyzed lung samples from 164 medico-legal autopsy cases, including 57 asphyxia/hypoxia deaths and 107 controls (non-asphyxial deaths). Peribronchial, perivascular and perialveolar MCs were detected using CD117 antibody, and the average of MCs in each of these locations was noted in each case. The results indicated a statistically significant increase in peribronchial and perialveolar mast cells (MC) in fatal asphyxial deaths, including those caused by hanging, drowning, or postural asphyxia. Peri-bronchial MC in lung sections of asphyxial deaths were in the range of 0.2-5.4 and in non-asphyxial samples were in the range of 0.0-2.2. Peri-alveolar MCs in lung sections of asphyxial deaths were in the range of 0.0-0.6 and in non-asphyxial samples were in the range of 0.0-0.2. Our data suggest that mast cells (MC) play an important role in fatal hypoxia-related mortality and CD 117 may be a reliable marker for detection of mast cells in asphyxial deaths. It could be very beneficial to forensic pathologists tasked with differentiating fatal asphyxia fatalities from other causes of death.

Delayed Death Due to Lightning: An Autopsy Case Report Highlighting Diagnostic and Medicolegal Issues.

The incidences of lightning strikes are not infrequent. The electric discharge of the lightning strike produces extreme heat and high amperage current, but fatality is reported in only about 10% to 30% of lightning cases. The spectrum of injuries due to lightning strikes can vary from no external injuries to typical external injuries. Merely the presence of superficial injuries due to lightning should not be considered sufficient to dismiss the case as non-serious. Rather clinicians should be wary of internal damage due to the effect of the lightning current as well as delayed complications of the lightning which can be fatal. Similarly, during an autopsy, the forensic pathologist should also investigate for the changes/damage in the internal organs due to the effect of lightning current. The present case reports the incidence of death due to delayed complications of a lightning strike which primary doctors initially overlooked. This case also discusses the histopathological changes in the internal organs due to lightning which can be helpful in the autopsy diagnosis of lightning, particularly in cases with no external or nonspecific injuries.

Computed Tomographic Evaluation of Cranial Suture Obliteration for Age Estimation in an Indian Population.

BACKGROUND: Age estimation is a critical aspect of human identification. Age is assessed using cranial suture obliteration, pelvic morphological changes, epiphyseal fusion of long bones, dental maturation, and other standard methods. METHODS: The present study investigated three-dimensional (3D) computed tomography (CT) scans of 263 individuals (183 males and 80 females) to assess the extent of ectocranial suture closure. The assessment of obliteration was done using a three-stage scoring method. Spearman's correlation coefficient (p < 0.05) was calculated to assess the relationship between cranial suture closure and chronological age. Simple and multiple linear regression models were developed using the cranial suture obliteration scores to estimate age. RESULTS: The standard errors of the estimate using multiple linear regression models developed for estimating age using obliteration scores of sagittal, coronal, and lambdoid sutures were 15.08 years in males, 13.27 years in females, and 14.74 years in the total study population. CONCLUSION: This study concludes that in the absence of additional skeletal age markers, this method can be used alone or in conjunction with other well-established methods of age assessment.

Knowledge, Attitude and Practices (KAP) of Medical Professionals on Euthanasia: A Study From a Tertiary Care Centre in India.

INTRODUCTION: Euthanasia or mercy killing has remained as a matter of extensive debate and ethical conflicts in the scientific literature. Discussions on this theme have got legal, religious, political and philosophical ramifications. AIM OF THE STUDY: The present study aimed to assess the knowledge, attitude and practices of medical professionals in a tertiary care hospital. METHODS: After taking prior approval from the institutional ethics committee a structured questionnaire was prepared and distributed among 200 consenting medical professionals in a tertiary care centre in the North-Western region of India. RESULTS: 50% of the respondents said that they were sure of the existing regulation on euthanasia in India. When gender differences were considered a significant difference (p=0.0147) was found between the two sexes regarding the alternate decision maker for deciding euthanasia. It was observed that there was a significant difference(p=0.0055) between those with the age more than 30 years and aged less than 30 years regarding the type of euthanasia that is justifiable. DISCUSSION: In the present study, the percentage of doctors favouring euthanasia is higher than compared in previous studies. The view of euthanasia is highly variable in different studies. Even though passive euthanasia has been legalised recently, there is an apprehension that it might be misused.

Fatal exsanguination following complete transection of femoral vessels due to angle grinder injury in an industrial accident.

Angle grinders are one of the most dangerous and frequently used tools in industrial settings. Angle grinder injuries range from superficial cuts to deep penetrating injuries with underlying fracture-dislocation and vascular trauma. The injuries caused by angle grinders mostly involve the head, face, or upper limbs, while the lower limb is an unusual site. The high-speed rotating disc of the angle grinders does not respect anatomical boundaries or structures; therefore, the injuries caused may be disfiguring, permanently incapacitating, or even fatal. We report a fatal case of an angle grinder injury to the lower limb. The victim sustained a sharp cut over the left thigh while woodworking in an industrial setup. The rotating disc of an angle grinder had transected the skin, subcutaneous fat and muscles, and both the femoral vessels of the left side, which led to fatal exsanguination within 10 min of the incident.

Ligature Strangulation in a Vehicular Accident Due to the Entanglement of a Shirt: An Autopsy Case.

Among the various types of asphyxial deaths, strangulation is one of the commonly encountered cases as structures in the neck make it vulnerable to fatality. In most such cases, ligature material, usually cloth, is used for the commission of the offense. Clothing may be associated with a wide range of both accidental and deliberately induced deaths. Accidental strangulation due to entrapment of the neck in clothing, especially in relation to vehicular accidents, has also been described in the literature, but these cases are mostly associated with long scarf-like clothing. Loose clothing and intoxication act as critical factors in entrapping the person in such an event. This case report highlights the rare occurrence of accidental strangulation due to the entanglement of clothing other than a long scarf consequent upon road traffic incident.

Snake venom - An unconventional recreational substance for psychonauts in India.

Psychoactive substances have been used by humankind for recreational purposes since time immemorial. The psychoactive properties of these substances are known to alter the consciousness, mood, and perception of people taking them. While the use of alcohol, opioids, and cannabinoids for recreational purposes has been researched thoroughly, cases of using psychoactive fauna or animal body parts for getting a 'high' are seldom reported. One such psychoactive substance used in India is snake venom. Snake venom has been reported to cause mood alteration, nociception, lethargy, and blurring of vision, and hence requires a careful review to delve into whether the recreational effects felt by the users can be attributed to constituents of snake venom or are solely due to self-induced effects.

Unusual subcutaneous emphysema extending to the limbs following blunt chest injury.

Subcutaneous emphysema can be traumatic, infectious, iatrogenic, or spontaneous. Traumatic subcutaneous emphysema of the upper limb is not infrequent following trauma to that limb. However, the subcutaneous emphysema of the limbs following trauma to a site other than the limb is seldom reported. A 45-year-old male was referred from a private hospital to a tertiary care hospital with right-sided multiple rib fractures and pneumothorax following chest injury. The patient was having acidotic breathing on examination, and crepitus was present over the bilateral chest and bilateral upper and lower limbs, suggesting subcutaneous emphysema. Right and left intercostal drainage tubes were inserted at our hospital. The patient died in the emergency after a few hours of treatment. The X-ray performed at the autopsy revealed extensive bilateral upper and lower limb subcutaneous emphysema. The deceased had multiple rib fractures over the right side with fractured ends of the two ribs piercing the pleural cavity, causing tears in the lung parenchyma. The cause of death was attributed to the chest injury and its sequelae. Such rapidly expanding subcutaneous emphysema can be a sign of underlying severe chest injury. Prompt insertion of the intercostal drainage tube could be the lifesaving procedure in such cases.

Anthropometry of the sternum: An autopsy-based study for sex determination.

Sex determination is one of the key components for establishing the individual's identity in forensic anthropology casework. It is a known fact that anthropometric assessment can have population-specific variations. The present autopsy study was conducted on the sterna of 102 cadavers (52 males and 50 females) of age more than 25 years at a tertiary care centre in Central India. Anthropometric measurements included the length of the manubrium (M), mesosternum (B) and combined length of manubrium and mesosternum (CL). Applicability of Hyrtl's law, Ashley's rule and the sternal index were also assessed for sex determination. A statistically significant correlation (p < 0.001) was observed between sternal measurements and the sex of the study population. The highest coefficient of correlation was seen between sex and the combined length (r = 0.726), followed by mesosternal length (r = 0.620), and manubrial length (r = 0.509). The difference between the means of the sternal index in males and females was not statistically significant (p > 0.05), and the difference between the means of the ratio of the body with manubrium in males and females for Hyrtl's law is also not found to be statistically significant (p > 0.05). It is concluded that the length of the body and the combined length of manubrium and mesosternum are valuable criteria for sexing the sternum in an adult population of Central India. The sternum can be useful for sex determination, particularly when bones like skull, pelvis, or long bones are not available or fragmented.

Management of the dead during coronavirus disease 2019 outbreak: Practices and perceptions of forensic practitioners from India.

The coronavirus disease 2019 pandemic has mandated a response from administrative agencies and the health sector globally, however, the number of cases and deaths continue to rise. While management of the living is paramount, the management of the dead is also important. Guidelines for managing the dead have been issued and implemented by various local administrations, in accordance with national and international guidelines. This questionnaire-based research aims to develop an understanding of the knowledge, perceptions and practices of forensic practitioners from India as regards the management of the dead during the coronavirus disease 2019 pandemic. This Pan-India study included 278 forensic medicine experts (249 males and 29 females) working in various hospitals and medical institutions across the country. The questionnaire included various issues involving the management of dead bodies in cases involving coronavirus disease 2019, such as infection control practices, body screening, handling and autopsy, disposal practices, local administrative policies, and available infrastructure and resources. We found that guidelines are mostly being followed across India, barring disparity in issues relating to testing in the dead bodies, the role of local administration in the body disposal, and the use of personal protective equipment while handling bodies and during autopsies. Mortuaries now need to be upgraded, and general infrastructure requires improvement. Periodic training of all stakeholders and assessment of facilities are recommended.

Electricity Induced Burns and Lung Injury: A Rare Autopsy Observation.

Electrocutions injuries are frequently encountered in a domestic setting or as an occupational hazard. Electrocutions injuries sustained in occupational settings are often associated with significant morbidity and mortality globally. Autopsy diagnosis of electrocution is mostly based on gross and histopathological changes in the entry and exit wounds. Gross changes in form of entry and exit wounds, however, may not be present in all cases of electrocution. In such cases, histopathological changes in the internal organs along the path of current can be useful. We report a case of fatal electrocution involving a 23-year-old young male in which remarkable gross and microscopic changes were appreciated in the lung due to the passage of electric current through it. Such observations are rarely reported in literature and highlight on the significance of autopsy pathology in the diagnosis of electrocution.

Unusual cutaneous presentation in a corrosive acid ingestion.

Corrosive digestive tract injuries are considered to be a source of morbidity and mortality worldwide. The cases of acid ingestion in Forensic Medicine practice are not infrequent. Corrosive ingestion usually presents with injuries over the face, oropharynx, esophagus, and gastrointestinal tract. We report a case of a 65-year-old woman who was brought to the emergency department with a history of ingestion of toilet cleaner at her home. Following this, she developed blackish-brown discoloration over the abdomen. The patient survived for less than one day. An autopsy confirmed the perforation of the stomach and small intestine. 500 ml of blackish fluid was present in the peritoneal cavity which resulted in corrosive peritonitis. The chemical examiner's report showed corrosive mixtures comprising sulfate, nitrate, and chloride ions in the peritoneal contents. This case report highlights atypical cutaneous presentation over the abdomen following corrosive acid ingestion, which has not been reported previously. The possible explanation for this cutaneous manifestation was corrosive effects of the underlying viscera due to its close proximation to the abdominal wall and presence of minimal intra-abdominal fat. A direct physical connection between perforation and cutaneous findings was not identified. The case emphasizes the need for a comprehensive approach in managing such cases, analyzing ingested material, and following standard autopsy protocols in case of death.

Fatal captive tiger attack - A case report with review of literature.

The attacks on humans by big captive felids has been an issue of concern for the administration of zoological parks and wildlife conservationists. The theme of human-animal conflict takes a new dimension for the wild animals kept in zoos, circuses, exotic animal farms, and private custody. Despite the potential dangers involved, the zookeepers have to closely interact with the captive tigers for catering to the needs of food, general health, and wellbeing. The literature has described cases of attacks by captive tigers resulting in the death of the primary caretaker. The injuries present on such bodies include multiple punctured lacerations, traumatic amputations, damage to the vital organs of the neck, fracture-dislocation of cervical vertebrae, and abrasions secondary to the dragging of the body. We present a rare fatal case of an attack of a tiger on keeper during the night hours while he entered the cage to look after the tiger who was suffering from gastroenteritis for a few days and was not taking his feed aptly. The keeper had a twelve-year long relation with the tiger, and the discovery of his death was an astonishment for zoo administration. This case describes the autopsy findings emphasizing the distribution of injuries, along with inquiring into the scene of the incident. The details about the predatory behaviour of tigers and stereotypic behaviours in captivity have been discussed.