Suicidal deaths in pregnancy at an apex institute in India: A retrospective analysis of autopsy cases.

OBJECTIVE: Suicidal behavior in pregnancy is a known fact worldwide. However, the published literature is still debating whether pregnancy is associated with an increase in the risk of suicide. Nonetheless, this is an important phenomenon that should not be ignored as the life of an unborn fetus is involved. The present study is a retrospective analysis of suicide death in pregnancy for the years 2011-2020 to study the different parameters. METHODS: The cases were collected from the archives of the department with due permission from the authority. Data were analyzed according to the age of the victim, duration of pregnancy, and time and cause of death. RESULT: The commonest age group was 21-25 years, the time of death was mostly during the daytime, and most of the deaths were due to hanging. These findings are not unusual in comparison to the general population. The pregnancy duration of most of the cases was first and second trimester, and third-trimester pregnancy accounted for far less number. In contrast, some studies showed that suicidal ideation and depression were more common during the first trimester and third trimester. Most of the pregnant women were pregnant with male fetuses. CONCLUSION: Though suicidal ideation is more during the first and third trimester, suicide occurs mostly in the first and second trimester, with third-trimester suicide deaths being far less. Being pregnant with a male fetus might be a risk factor in comparison to having female fetuses. These are two aspects that need to be explored further.

Mortality analysis of COVID-19 cases during the second wave and its comparison with the first wave: A hospital-based study.

Objectives: This study was undertaken to determine the characteristics of COVID-19 deaths during the second wave and to compare these characteristics with the mortality during the first wave in a dedicated COVID hospital (DCH). Study Design: It was a hospital record-based descriptive study. Methodology: The study was conducted in a tertiary care COVID hospital, using a standard death audit proforma. The data were analyzed to know various demographic characteristics and factors related to mortality during the second wave from March to June 2021. The findings were compared with the mortality data during the first wave from April to July 2020 at the same hospital. Results: A total of 264 deaths occurred at the center during the study period with a mortality rate of 22.8%. Male cases were more in number, the age group was 21-70 years, the highest number of mortality was seen in the mid of the study period, duration of stay was five days on average and common causes of death were pneumonia alone or with acute respiratory distress syndrome with sepsis. In comparison to the first wave, the mortality rate was four times higher, the age group was younger and opportunistic infections viz. mucormycosis and aspergillosis were present during the second wave. Conclusion: The mortality rate was significantly higher and the younger age groups were involved during the second wave, with opportunistic fungal infections due to the use of immunomodulators.

Are numbers deceptive? Is death auditing a solution for death analysis, among the COVID-19 deceased?: A study from a dedicated COVID-19 hospital in Faridabad, Haryana.

BACKGROUND: COVID-19 pandemic has havocked the entire world and India has not been spared. The focus is not only on the containment but on the reduction in mortality also. The objective of the study was to know the trend of COVID-19 deaths in a 510-bedded dedicated COVID-19 hospital and to determine the cause of death and various factors associated with these deaths. METHOD: A descriptive study was conducted in a COVID-dedicated hospital setting to analyze deaths occurring during April--July, 2020 using a standard death audit proforma. RESULTS: A total number of 95 COVID-19 patients died in ICU. The mortality rate among ICU patients varied from 24.6% to 52.9%. Most of the cases were referred from other hospitals. About 64% of the deceased was admitted in severe condition and 34% of cases were referred on ventilator support. The week-wise trend revealed a positive association between the number of deaths and the number of referred cases as well as the number of patients received on ventilator support and in severe condition. About one-third of cases were late in seeking treatment at health centers with the same weekly trend. Being unaware of the condition (1%) and the stigma associated with the disease (32%) were the reasons behind it. Common direct causes of death were pneumonia (73%), pneumonia complicated with sepsis (16%), and acute respiratory disease syndrome (ARDS) (7%). CONCLUSION: High case fatality rate in the ICU of a referral COVID-dedicated hospital is mainly because of the admission of patients in severe conditions.

Histopathological Differentiation of Antemortem and Postmortem Electrical Burn Mark Produced by Low Voltage.

ABSTRACT: The study was undertaken to differentiate antemortem electrical (AME) and postmortem electrical (PME) burn marks with the help of histopathology. The electrical burn mark was produced on 25 dead bodies. Alongside 25 cases of electrocution deaths were included for comparison. Slides were prepared and stained with hematoxylin-eosin stains. Intraepidermal and subepidermal separation; coagulative necrosis of the epidermis; nuclear elongation and hyperchromasia of epidermal cells; homogenization of the dermis; nuclear elongation and hyperchromasia of hair follicles, sweat glands, sebaceous glands, and blood vessel endothelium were studied for histopathological changes and graded. The findings of the study suggest that the histopathological changes in electrical burn marks are due to the physical effect of heat produced by the electric current. The classical histopathological features of electrical burn mark cannot differentiate between AME and PME burn marks. However, careful evaluation of grading of the dermal changes can be helpful in differentiating AME and PME burn marks. Highest grade of dermal thickness homogenization and highest grade of nuclear elongation of dermal appendages were significantly more in the antemortem electrical burn marks than PME burn marks.

Biochemical findings in sudden unexpected death in epilepsy: Hospital based case-control study.

PURPOSE: A review study on the biochemistry of epilepsy showed that in epileptic patients, serum glucose and cholesterol concentrations are low, sodium is unaffected, potassium increases, glucose is high and mild hypocalcemia. We have conducted a biochemical study on sudden unexpected death in epilepsy (SUDEP) cases in an attempt to establish the characteristic biochemical values to diagnose these deaths. METHODS: This was a hospital based case-control study done at All India Institute of Medical Sciences, New Delhi for one year. Twenty SUDEP cases and 20 age- and sex-matched controls were included in the study. Femoral blood, cerebrospinal fluid, vitreous humor, and pericardial fluid were biochemically analyzed for sodium, potassium, calcium, glucose, N-acetyl- cysteine activated creatine kinase (CK-NAC) and isoenzyme CK-MB. RESULT: Serum sodium, CK-MB and CK-NAC level was found significantly increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths. Likewise, in CSF, sodium and CK-NAC was found increased and potassium level was found decreased in SUDEP cases. In vitreous humor, sodium and CK-MB level was found increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths. In pericardial fluid, sodium, CK-NAC and CK-MB level was found increased and potassium level was found decreased in SUDEP cases in comparison to non-epileptic deaths. CONCLUSION: It concludes that high sodium level and low potassium level could be associated with SUDEP. However, this is a small size study, a larger study is needed to verify the findings. Furthermore, it is difficult to conclude whether these findings are exclusive to SUDEP.

Prescription drug suicide in non-abusers: A 6-year forensic survey.

BACKGROUND: Prescription drug suicide merits study to guide the development of strategies to reduce suicide risk. We examined prescription drug suicide specifically in non-abusers of prescription drugs; this is a relatively unexplored subject. METHODS: Six-year data on prescription drug suicide in non-abusers were extracted from the records of the Department of Forensic Medicine at the All India Institute of Medical Sciences, New Delhi. These records contained information obtained from the scene of the suicide, from interviews with relatives of the deceased, and from forensic toxicological analyses at two laboratories. RESULTS: There were 27 (8%) cases of prescription drug suicide in non-abusers out of 338 cases of suicidal poisoning. The mean age of this sample was 26 years. The sample was 74% male. Nearly half of the cases (44%) were students. A combination of dextropropoxyphene with dicyclomine, with or without paracetamol, was used by 41% of cases. Overdose was achieved through the ingestion of 10-40 (median, 30) tablets or by the injection of 2-3 (median, 2) vials of medication. In 52% of cases, it appeared that the drugs had been procured over the counter. CONCLUSIONS: It is reassuring that the absolute number of prescription drug suicides in non-abusers was small; the findings, however, are important because they could serve as a baseline for assessing time trends in future studies. For the present, we suggest that prescription drugs of potential abuse, especially those containing opioids and antispasmodics, should be prescribed and dispensed judiciously, especially to youth.

Association of menstruation cycle with completed suicide: a hospital-based case-control study.

The purpose of the study was to determine the phases of the menstrual cycle in the reproductive age group of females who committed suicide as compared with a control group of females who died from causes other than suicide. The study included 86 cases in the suicidal group and 80 cases in the non-suicidal group. The menstrual phase was decided by the gross and histological examination of the uterus and ovary at autopsy. Deaths were more common during the secretory phase (56.9%) in the suicidal group, while in the non-suicidal group, death occurred more commonly in the proliferative phase (66.3%). In reference to proliferative phase, deaths were more in the secretory phase and menstrual phase in the suicidal group, adjusted odd's ratio (OR) being 3.7 (p = 0.042) and 4.7 (p = 0.032), respectively. Corpus luteum was present in the right ovary of 43 and 14 victims of suicidal and non-suicidal deaths, respectively, while it was in the left ovary of 3 and 11 victims of suicidal and non-suicidal death, respectively. Odd's ratio was 10.3 for corpus luteum to be in the right ovary in comparison with the left ovary for the suicidal group (p = 0.001). This study revealed that suicidal chances in a woman are significantly more in the menstrual phase and the secretory phase of the menstrual cycle. The presence of corpus luteum in the right ovary is associated with an increased risk of suicide, but the reason is not known.

Homicide patterns for the last 20 years in South and South East Delhi, India.

Homicide patterns are a useful indicator of social stress in a community, and they provide law-enforcement authorities with helpful information. This study was undertaken at the All India Institute of Medical Sciences, New Delhi, India, in order to understand the regional pattern of homicide. Data from the last 20 years were analysed. There were a total of 1048 male and 323 female homicide cases. The male/female ratio was about 3:1, and the proportion of total autopsies was approximately 4% for both sexes. The most common age group was 11-40 years old. Female cases were more common during the monsoon season, but male cases did not show any such variation. Blunt-force head injury, stabbing, strangulation and shooting were the most common methods, and the head, neck and chest were the most commonly targeted areas. Defence injuries were seen in 7.9% cases, significantly more often amongst men, most of which were active and in the form of incised wounds. About 17% of cases survived in hospital for up to a month before succumbing to their injuries, with males being in their 50s and 60s and females in younger age groups. Most of these cases suffered a gunshot wound, followed by a head injury and a stab wound.

Body Coloration Artifacts Encountered at Medicolegal Autopsy in India.

Application of color on the external body surface before, during, and after death, such as during a festivity, cultural occasion, or after death ritual, can present as an artifact at forensic autopsy. The present study is a retrospective review of body color artifacts collected from postmortem reports, inquest papers and photographs of each individual case autopsied at our institutes during a 12 year period from 2004 to 2015. The reason for body colorations were various festivities, after death rituals and beautification products, among others. The body coloration mimicked antemortem changes, such as cyanosis, injury, jaundice, and congestion, as well as postmortem changes, such as postmortem lividity and early decomposition changes. These artifacts were differentiated by seeing the body before the washing of the color, history of the application of the color, and by various additional features, such as unusual appearance, distribution, and sites. They were not supported by any other findings on the body to consider them as genuine antemortem or postmortem findings.

Homicidal poisoning in India: A short review.

This review has analysed various studies and case reports on homicide by poison from different parts of India till date. This review shows that homicidal poisoning prevalence varies from 0.3% to 3.7% having varied prevalence from different regions with no homicidal cases too. The poisons used in homicide were mainly organophosphates, aluminium phosphide, paraquat, and arsenic. No age-group or gender was spared and the perpetrators were first degree relatives.

Adipocere Formation in Subtropical Climate of Northern India: A Retrospective Study.

Adipocere formation depends upon multiple environmental factors. In comparison with temperate countries, it usually develops early in the subtropical climate. We have studied a retrospective data of 31 cases with adipocere formation at Department of Forensic Medicine at All India Institute of Medical Sciences, New Delhi. Most of the cases were recovered during the month of May to October from closed rooms at home, open grounds, open forest areas, various water sources, and riverbanks. The time duration of recovery from the time of death was from 12 h to 7 days 12 h. In 10 cases, adipocere formation was seen within 2 days, and in four male cases among them, the adipocere formed within a day. Most of the bodies showing adipocere formation within 2 days were recovered from land. These facts showed that subtropical climate having hot and humid weather promotes early adipocere formation compared to temperate climate.

Accidental cut-throat injuries from the broken windshield of an auto rickshaw: Two unusual cases.

Accidental cut-throat injuries are extremely rare and usually involve a sharp-edged weapon. In this paper, two cases of a cut-throat wound to two auto-rickshaw drivers are presented where the broken windshield of the auto-rickshaws was responsible for the wounds. In both the cases, fatal incised wounds were present over the neck, cutting the soft tissue along with the major vessels. The death occurred due to exsanguination caused by neck-vessel injury in one case and trachea along with neck-vessel injury in the second case. Although the wounds on the neck initially suggested homicide, they were found to have occurred accidentally as a result of a road traffic accident involving a head-on collision of auto rickshaws. The injuries were inflicted by the shattered glass of the windshield.

A Rare Fatal Complication of Llizarov Procedure.

Ilizarov process is used for the management of multiple fractures, polytrauma conditions, cosmetic limb lengthening, and fracture malunion. Complications associated with the process are nerve palsy, joint contracture, premature or delayed osseous consolidation, a nonunion and permanent stiffness of the joint, pin tract infection, edema, and transient paresthesia, etc. In our case, there was a fatal complication. A 25-year-old African lady underwent the Ilizarov procedure for femur lengthening in a hospital in New Delhi, India. During her first distraction process, she suddenly collapsed at the hospital and could not be revived. At postmortem, a small hematoma was seen around the surgically fractured area. On histopathology of internal organs, fat globules were present in the vasculature of brain and lungs. Cause of death was opined as due to fat embolism. This is the first case reported of a fatal fat embolism following Ilizarov procedure for limb lengthening in a healthy adult.

Self-Strangulation Turning into Partial Hanging for a Suicide Victim.

Hanging is the most common asphyxial method of suicide, whereas suicide by strangulation is unusual. Here, we are reporting a particular methodology of the asphyxial method of suicide in which a case of self-strangulation culminated into partial hanging. A 30-year-old male wrapped one end of the cable wire around his neck. He then passed the other end over a curtain rod and tied that end around the right hand. He pulled the hand down, using the curtain rod as a fulcrum, to tighten the noose around the neck in an attempt to strangulate himself. However, he lost consciousness during the process and the body slipped down, pulling the right hand up which got stuck at the curtain rod. This led the body hanged in the kneeling position. This bizarre scenario raised suspicion of homicide but the crime scene, autopsy and victim characteristics were in favor of suicide.

Unique cardiac anomaly due to lateralization of a straight trunco-conal septum

Congenital heart disease is present in 4-50/1000 live births worldwide, causing about 10% of infant mortality. Congenital heart disease arises when there is a defect in the process of development of the heart through looping, remodeling, realignment and septation of the primitive endothelial tube. Here we describe a case of congenital heart disease where there was formation of straight truncoconal septum with lateralization. It has caused transposition of great vessels, atretic non communicating stenosed pulmonary trunk, and blind outflow tract of left ventricle. There was renal anomaly too in the form of horseshoe kidney. The entire developmental anomaly could be traced back to the period between the 6th and the 9th week of intrauterine life. The neonate died within half an hour of birth

No disponible

Fatal carbon monoxide poisoning: A lesson from a retrospective study at All India Institute of Medical Sciences, New Delhi.

BACKGROUND: Carbon monoxide (CO) is a colorless, odorless, tasteless, and nonirritating gas which makes it difficult for those who are exposed, to detect it, leading to unexpected death. This study was undertaken to see the pattern of fatal CO poisoning and to discuss preventive aspect. MATERIALS AND METHODS: It was a retrospective descriptive study of fatal CO cases which were autopsied at All India Institute of Medical Sciences, New Delhi, from the year 2010 to the year 2015. The cases were analyzed as per age groups, circumstances of death, season of death, and sources of CO formation. RESULTS AND DISCUSSION: The study involved 40 cases of fatal CO poisoning. About 80% of cases were reported in winter months. The maximum cases were reported in the month of January followed by November and December. All the cases except one, died with a source of CO nearby and the person was inside a room or some closed space without ventilation. Source of CO was firepot and electric room heater in most of the cases. Some cases were of CO build inside the car with a running engine. Most of the cases occurred accidentally. CONCLUSION: Clustering of cases is seen in winters. Poisoning can occur in different ways. The study documents the various possibilities of CO poisoning and advocates community education targeting the high-risk groups and masses, especially during the winter season.