Insight to the psychosocial factors of survivors of suicidal hanging.

Introduction: The incidence of hanging has increased over the last ten years and is the most common method of suicide. Because of its multifactorial causation, the reason behind hanging remains unfolded unless the victims leave a suicidal note. In the present study, the psychodynamic factors of hanging were assessed among the survivors of suicidal hanging. Materials and Methods: The cross-sectional study was conducted at S.C.B Medical College and Hospital, Cuttack, India, over a period of three years. Eighty-two individuals admitted in medicine ward of this tertiary care hospital to receive treatment for the complications as a sequel of hanging and willing to participate in study were included after obtaining informed consent. The information was recorded in a pre-designed pro forma. Results: Subjects from rural areas (87.8%) and low socio-economic backgrounds (67.1%) attempted suicide more often. Most of the victims were in the age group of 21-30 years, followed by less than 20 years. The most common cause of attempted suicide by hanging was family-related issues, and mainly by immediately available materials like dupattas, saree, lungi, and other fabrics. Females in rural areas and males from urban areas attempted suicide by hanging in significantly higher proportions (P = 0.041). Conclusion: Most people commit suicide at a younger age due to failure to cope with the different stressful situations. The most common reason for attempted suicide by hanging was family-related issues. Early intervention in family disputes in developing countries, especially in younger individuals, may help to curb suicide.

External challenges for specialists dealing with forensic autopsies.

BACKGROUND: In addition to poor infrastructure, and human resource constraints, forensic medicine specialists in developing countries face many external challenges. OBJECTIVES: We aimed to investigate the prevalence, type, and source of external challenges confronting them including sex, age, religion, deceased's place of residence and the number of accompanying relatives. MATERIALS AND METHODS: This cross-sectional, observational study was conducted between August 2020 and July 2022 at the Mortuary of AIIMS, Bhubaneswar with the approval of the ethical committee. RESULTS: Of note, forensic medicine specialists faced external challenges in about one in five cases (20.5%). Most demands were to either minimise the autopsy procedure (n = 65) or to conduct the autopsy at inappropriate times (n = 58). The demands to minimise the autopsy procedure were significantly associated with the deceased's age (p = 0.046), religion (p = 0.010), socioeconomic class (p = 0.020) and manner of death (p = 0.019). CONCLUSIONS: Our study found that forensic medicine specialists in India face significant external challenges. Avoiding unnecessary complete autopsies, implementing night autopsies, and embracing minimally invasive autopsies are recommended to mitigate these challenges.

Adverse Childhood Experiences, Aggression, Empathy, and Psychopathology in Adult Males Accused of Rape.

Background: Investigating the underlying psychosocial factors is a cornerstone of planning need-based intervention for adult males accused of rape. Unresolved debates on its etiology, mediation, or interaction among causal psychosocial variables fuel curiosity to scrutinize it further. Hence, we studied potential influence of and relation between adverse childhood experiences, aggression, empathy, and psychopathology in adult males accused of rape in India and investigated the risk factors for the same. Methods: With a correlational research design, 40 literate and consenting adult males medically confirmed for rape were recruited using convenient sampling. The assessment was done on Adverse Childhood Experiences, Aggression Questionnaire, Symptom Checklist-90, and Interpersonal Reactivity Index. Descriptive statistics, Pearson's product-moment correlation, and stepwise linear regression analysis were calculated. Results: Approximately 75% of the participants experienced at least one category of Adverse Childhood Experiences. Scores above cut-off points were obtained on anger, hostility, fantasy, and personal distress. Significant correlations were obtained between adverse childhood experiences and psychopathology; between hostility and psychopathology, perspective taking, and personal distress; and in case of indirect aggression, with perspective taking and empathetic concerns. Regression analysis revealed that an increase in Symptom Checklist-90 global scores increases hostility and that lower personal distress predicts higher scores on hostility on Aggression Questionnaire. Conclusions: Adverse childhood experiences, aggression, and psychopathology play a critical role and, therefore, should be included as core components of the prevention of rape or relapse prevention programs at the community level.

Management of Mass Death in COVID-19 Pandemic in an Indian Perspective.

Current international experience has shown the vulnerability of health-care systems of developed nations, and of developing nations such as India, to coronavirus disease 2019 (COVID-19). COVID-19 pandemic is a disaster with mass casualties. International experience has revealed that, even in the countries where mass disasters are less frequent and not involved in conflicts, they are overwhelmed with COVID-19 deaths. Although, in the current scenario with fewer deaths, India's health-care system can handle the situation of COVID-19 but should be prepared for the worst in terms of appropriate management, and adequate infection prevention measures including handling the dead without hampering the dignity of the deceased and of the surviving family. Before any crisis overwhelms responders and resources, emergency response plans should be established and activated to ensure the reliable identification and documentation of the dead. The current review was carried out to recommend the proper management of dead bodies in the COVID-19 mass disaster with a particular focus on resource-poor countries, such as India.

Complicated central catheterization in atypical celphos poisoning simulating throttling homicide: Review of neck resuscitation artefacts.

Therapeutic artefacts are a challenge for forensic pathologists for correct interpretation at autopsy. A 23-year-old female was found unconscious at home and immediately admitted to an emergency of a tertiary care hospital where resuscitative measures were taken. However, she died after 4 h of hospitalization. The injuries (abrasions, subcutaneous bruising and haemorrhage in the deep structures of the neck) discovered at autopsy simulated the findings of throttling and aroused the suspicion of homicide. Later, enquiry revealed that it happened due to mal-positioned central line in the carotid artery during internal jugular vein access to provide fluid as the patient was in shock due to aluminium phosphide (Celphos)poisoning. The bleeding diatheses in Celphos poisoning might have precipitated the extensive neck haemorrhage in this case.

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.

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.

Suicidal asphyxiation by carbon monoxide within a polythene bag.

Suicide by inhalation of carbon monoxide is not uncommon and usually involves car exhausts or burning charcoal or defective boilers. We report a case of a 25-year-old man, who committed suicide by inhaling carbon monoxide gas inside a polythene bag in a bathroom. The open carbon monoxide cylinder found inside the polythene bag was purchased online by the deceased a few days earlier. He had stated that the gas would be used for his experiment on the environment. A suicide note recovered from his trouser pocket revealed his intention for a painless death.

Five-year study of unidentified/unclaimed and unknown deaths brought for medicolegal autopsy at Premier Hospital in New Delhi, India.

Delhi is the second largest city of the world both in terms of population and area, as well as being the capital of India. Every year, thousands of people from different states throng to the capital in search of a job in order to earn a living. When these people die and their bodies are found without any identifying documentation, it is very difficult for the police to establish their identities. These bodies are labelled as unidentified/unclaimed or unknown, and are sent for usually sent for medicolegal autopsy. Invariably, skeletonised bodies are also recovered, which are also subjected to medicolegal autopsy. Female foeticide is another social problem, and whenever such foetuses are disposed of illegally, they are also grouped under this category and brought for medicolegal autopsy. We undertook a five-year retrospective analysis (for the period 2010-2014) of all such cases brought for medicolegal autopsy at our centre, which caters only for the south and south-east districts of Delhi. A total of 7964 cases were brought for medicolegal autopsy, of which unknown cases accounted for about 16%. About 25-30 foetuses and skeletonised bodies were brought each year that was studied. The manner of death was certified as natural in about 71% of cases, with predominant pathology in the lungs. There was a clear predominance of males over females, with the 31- to 50-year age group accounting for half of all cases. There was an increase in the number of deaths during months of extreme temperatures. The average time between the recovery of a body by the police and the post-mortem was about seven days. These findings raise many questions, including the failure of governmental policies, police investigating agencies and social menace. The creation of a national missing-persons database as well as a DNA databank is needed to aid in the identification of unidentified/unclaimed and unknown bodies.

Jumping Together: A Fatal Suicide Pact.

In suicide pact, two or more victims mutually agree and execute to end their lives together by predetermined method, preferably by hanging, drowning, gunshot, or poisoning. The victims are usually spouses, lovers, or friends, and the reasons behind such steps are various. In this reported suicide pact, husband-wife duo jumped from the terrace of a 12-meter-high building with their wrist bound to each other. Although they jumped together, the injury patterns were completely different. The man landed on head sustaining mainly craniocerebral injuries, and the wife landed on feet sustaining long bone injuries. They left a suicide note pointing out sudden demise of their only child as the reason for the suicide, and it was signed by both of them. Jumping from a height in suicide pact has not been reported in the scientific literature yet.

Fatal corrosive ingestion: A study from South and South-East Delhi, India (2005-2014).

The study presents a retrospective analysis of 64 cases of death resulting from ingestion of corrosive substances. The cases represented approximately 0.4% of all autopsies conducted and 13.6% of all fatal poisonings studied during the 10-year period from January 2005 to December 2014 at the Department of Forensic Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi. The data was analyzed with regard to age, sex, nature and source of corrosive substance used, survival period, cause and manner of death. Males (64.06%) outnumbered females (35.94%), with a male-to-female ratio of 1.78:1. The most common age group involved was 21-30 years (35.94%). Sulfuric acid (68.75%) presented as the most common corrosive substance ingested. Household cleaning substances (39.06%) were identified as a common source of such type of corrosive substance, but the exact source could not be identified in 56.26% of cases. In the majority of cases (46.88%) death was due to perforation peritonitis. Most of the victims (54.69%) succumbed to their injuries within a day of ingestion. In 87.5% of cases, the corrosive substance was consumed for suicidal purposes. A strict regulatory framework is required for the production, distribution, storage and use of corrosive substances. Preventive guidelines and creating awareness among the masses will go a long way towards curbing such unfortunate incidents.

Fatal chilli bite.

A healthy 2-year-old girl bit a green chilli accidentally following which she had many bouts of vomiting. She became unconscious and was immediately admitted to hospital. In spite of all medical intervention, she died after one day. The autopsy confirmed that the death was caused by respiratory failure due to acute respiratory distress syndrome following aspiration of gastric contents into tracheobronchial tree. Aspiration of gastric contents resulting in acute respiratory distress syndrome and death is not uncommon; however, death following the accidental bite of a chilli is rarely reported in medical-legal literature.

An Adolescent with Bestiality Behaviour: Psychological Evaluation and Community Health Concerns.

Bestiality is a serious but less commonly reported form of animal cruelty occurring in a society. It is a punishable sexual offence in India. Bestiality has received little attention in recent psychiatric literature, and even though case reports have been published, an elaborate psychological assessment is often missing. This case report of 18 year old male presented here highlighted the importance of psychological assessment to emphasize on its implications for the further risk assessment of the person, family psycho-education and non-pharmacological intervention for bestialists. The overall assessment suggested of absence of any brain dysfunction and active psychopathology, average intelligence (IQ) and intact cognitive functioning. The findings portrayed physical and sexual inadequacies, emotional and sexual immaturity, difficulty in emotional attachment, internalized hostility, voyeuristic tendencies and infantile social behaviour, excitement seeker, inability to delay gratification of impulses, lacks empathy, poor self-discipline, less conscientiousness and less sensitive to criticism. The report also emphasized the role of child sexual abuse on sexual behavior later life. The importance of including the topic within the community health/sexual and reproductive health education programmes was highlighted.

Sudden death of a child due to respiratory diphtheria.

A four-year-old girl presented to the emergency department with respiratory distress. Death occurred despite attempted resuscitation. The illness was not clinically diagnosed. Her father revealed that she had a fever and sore throat for the last four days and was not immunised for diphtheria. Characteristic gross and microscopic pathology of respiratory diphtheria and microbiological findings were observed. The cause of death was acute respiratory failure consequent upon upper airway obstruction from diphtheria. Forensic pathologists should remember that the diphtheria cases can cause sudden death especially in developing countries.

Skin suicide note written in mehndi (henna).

Suicide messages on the skin are rare. Until now, in all reported cases, the writing tool used by the victims has been a pen. We report a suicide case by hanging in which the victim had written a note on her palm in mehndi, or henna, at a wedding ceremony three days before the fatal act. The note was discovered at autopsy.

Cardiac rupture delayed for a week in an asymptomatic child following blunt trauma.

A two-year-old child was hit by a car outside his home and was immediately taken to hospital. There were no external injuries present over the body except two small abrasions on the occipital region of head. A computed tomography scan of the head was performed which revealed no cranio-cerebral injury. He was discharged from the hospital within few hours apparently well. The child was absolutely asymptomatic for a week, after which he suddenly died while playing at home. Autopsy revealed left ventricular free wall rupture and pericardial haematoma. This case report discusses the rare incidence of delayed cardiac rupture due to blunt trauma resulting in haemorrhagic tamponade in an asymptomatic child.

Estimation of post-mortem interval: A comparison between cerebrospinal fluid and vitreous humour chemistry.

Accurate estimation of post-mortem interval is of great importance in medico-legal autopsy cases. The present study is intended to compare the accuracy of estimating post-mortem interval from biochemical parameters of vitreous humour and cerebrospinal fluid (CSF). Both the fluids were collected from 100 medico-legal autopsies with known time of death and analysed for potassium, glucose, sodium, calcium, urea and creatinine. The current study found that vitreous humour is a better fluid in comparison to CSF for estimation of post-mortem interval. It is also observed that among the statistically significant parameters in both the fluids, level of potassium and sodium in vitreous humour are giving more accurate results in comparison to their corresponding parameters in CSF while accuracy of glucose is more or less same in both the fluid. Nevertheless potassium concentration in vitreous humour is a single best time honoured parameter to estimate post-mortem interval.

Suicide by injecting lispro insulin with an intravenous cannula.

Suicide by injecting insulin is not uncommon both in diabetic and non-diabetic people. The victim usually uses an insulin syringe or a traditional syringe attached to a needle for the injection of insulin, of either animal or synthetic origin. We report a case of suicide by a non-diabetic physician by injecting lispro insulin through an intravenous cannula. To the best of our knowledge, the use of an intravenous cannula for the injection of insulin for suicide is unusual and is rarely reported in the medico-legal literature.

Bluish discolouration of stomach in dextropropoxyphene poisoning: an unusual finding at autopsy and discussion of differential diagnosis.

Many times at autopsy, on the basis of colour change of the stomach and intestinal mucosa, the forensic pathologist is able to suspect a particular nature of poisoning which leads to conclusive investigation of the case. An intense bluish discolouration of the gastric mucosa owing to capsule shell instead of the content is rarely encountered at autopsy. We report a case of fatal dextropropoxyphene poisoning, where gastric and small intestinal mucosa showed bluish discolouration owing to the gelatine capsule of the drug. Other causes of bluish discolouration of gastrointestinal tract mucosa at autopsy are also discussed.