Indian Journal of Forensic Medicine and Pathology

Background: Differentiation between traumatic injuries and pathological lesions continues to be one of the challenges in medico-legal practice, especially as intracranial tumours sometimes present features similar to the appearance of entrance or exit wounds caused by gunfire. These misunderstandings may completely change the medico-legal scenario of the case, wrongly implicating homicide or concealment of crime. Objective: The article attempts to analyse the forensic challenges involved when post-mortem ballistic trauma to the skull is mistaken with tumour-related anomalies, and to evaluate how Indian medico-legal systems, including the Bharatiya Sakshya Adhiniyam, 2023, address the evidentiary implications of such intersections. Methods: A search was carried out on PubMed, Scopus, Web of Science, ResearchGate and Google Scholar between 1997 and 2024. The review gradually deliberates the information recycled from ongoing scientific literature and landmark case reports, legal-medico tenets emanating from the Indian setting, integrating the contribution of forensic athology, forensic radiology and digital autopsy practices. Results:Results indicate that cranial tumours may radiologically or morphologically mimic a gunshot wound, posing a significant problem for the investigator. The integration of neuropathology and forensic reconstruction, together with a supraspecialistic expert testimony, is necessary for removing doubts and enabling forensic admissibility of the evidence. Conclusion: An interdisciplinary approach is necessary to prevent miscarriage of justice in suspected headshot deaths with occult neoplasms by combining forensic medicine and law. More use of scientific benchmarks, admissibility standards, and expert interpretation may protect fair trial rights in cases of such complexity. Key Messages: Cranial tumours can be mistaken for gunshot wounds, and this can carry grave medico-legal implications with miscarriages of justice involving false convictions or acquittals. To obtain precision, it is necessary to cooperate with several disciplines, including forensic pathology, radiology and digital autopsy. Definitional clarity, stringent evidentiary standards and empirical validation are critical to admissibility under Bharatiya Sakshya Adhiniyam, 2023, and call for a closer nexus between law and medicine to preclude unjust verdicts.

Introduction: Accurate, complete, and timely medical documentation is a cornerstone of safe and effective healthcare delivery. It ensures continuity of care, facilitates communication among healthcare providers, and serves as an essential medico-legal record. Inadequate or incomplete documentation can compromise patient safety, lead to diagnostic or therapeutic delays, and expose practitioners to legal liability. This study aims to assess the quality and completeness of inpatient medical records across multiple clinical departments in a tertiary care hospital and to examine the legal and ethical implications associated with documentation deficiencies. Materials and methods: A retrospective descriptive study was conducted in a 1250- bed multispecialty teaching hospital. Medical records from nine departments like Internal Medicine, Gynaecology & Obstetrics, Forensic Medicine & Toxicology, General Surgery, ENT, Ophthalmology, Paediatrics, Dermatology, and Psychiatry were evaluated. Using systematic random sampling, 50 inpatient case sheets were selected from each department, yielding a total sample of 450 records from April 2022 to April 2023. A structured 12-domain audit tool assessing demographics, admission details, history, examination findings, investigations, diagnosis, treatment notes, procedure-related entries, daily progress, discharge summaries, signatures, and supporting documents was used to analyze documentation completeness. Results: The audit revealed marked inter-departmental variation in documentation standards. Forensic Medicine & Toxicology demonstrated the highest accuracy, with only 1.1% cumulative documentation errors, reflecting stringent medico-legal protocols. The highest deficiencies were observed in Internal Medicine (18.5%) and General Surgery (11.7%), largely involving incomplete demographic entries, irregular clinical notes, missing time documentation, and inconsistent filing of supporting documents. Additional lapses were noted in operative notes, weekend entries, and signature authentication across several departments. Conclusion:Regular audits, training in medical record-keeping and implementation of standardized documentation protocols are essential to improve the quality of medical records and reduce medico-legal risks. Strengthening documentation practices supports better patient care, enhances institutional accountability, and safeguards healthcare professionals in legal contexts.

Context: Autopsy remains an invaluable tool in the advancement of pathological knowledge, particularly through the identification of rare or incidental neoplastic and non neoplastic lesions that may otherwise remain undetected during life. Many such findings are asymptomatic and cause no significant functional impairment. This study aims to underscore the significance of the incidental neoplastic lesions in pathological medicolegal autopsies. Aim: To determine the spectrum of histopathological findings in neoplastic lesions identified during autopsy, whether or not they were related to the cause of death. Materials and Methods: A retrospective review of medicolegal autopsies conducted over a period of one year at a tertiary care center was performed. Histopathological examinations were carried out and the findings were analyzed to identify neoplastic lesions. Results: The present study consisted of a series of 303 autopsy cases from Department of Pathology in a tertiary care hospital conducted over a period of one year. The internal organs of total of 303 autopsies were sent for histopathological examination. Neoplastic lesions were identified in 4.95% of cases. Conclusion: This study has added valuable insights to the repository of rare incidental neoplastic lesions. Autopsy studies remain crucial for uncovering clinically silent yet potentially significant pathological conditions, some of which could have impacted patient management if identified antemortem.

Background: Stature estimation is a crucial element of forensic identification, specifically in cases involving mass disasters and unknown bodies. Establishing reliable associations between body measurements and height is essential for accurate identification. Aim: To assess the association between middle finger length and height among adults in Visakhapatnam, Andhra Pradesh Materials and Methods: Cross-sectional research was carried out with 147 subjects (75 males and 72 females) aged 21 years and above, ensuring completion of skeletal growth with fused secondary ossification centres. The mean age was 26.82 years. Stature was recorded in centimetres, and middle finger lengths (right and left) were recorded. Results: The mean height of subjects was 162.04 ± 8.51 cm. The mean right and left middle finger lengths were 7.44 cm and 7.3 cm, respectively. A notable association was found between middle finger length and height for both hands (p < 0.0001). The right middle finger showed a slightly stronger predictive value than the left. Conclusion: Middle finger length serves as a notable and reliable predictor of height. Both right and left middle fingers can be effectively used for height estimation, making this approach valuable in forensic cases where only partial remains are available.

Background: social media is widely used by medical students for communication, learning, and networking. However, it can blur personal–professional boundaries, posing ethical challenges related to confidentiality and professionalism. Aim: To assess patterns of social media use, awareness of e-professionalism, and prevalence of unprofessional behaviour among clinical-year MBBS students. Objectives: To assess social media usage, awareness of e-professionalism guidelines, and prevalence of unprofessional conduct, and to explore associations between privacy practices and professionalism breaches. Materials and Methods: A cross-sectional online survey was conducted among 334 clinical-year MBBS students at Chettinad Hospital and Research Institute using a pre-validated questionnaire. Data included demographics, usage patterns, posting behaviours, and policy awareness. Results: Most participants (58.1%) were aged 21–23 years and female (62.9%). WhatsApp (97.3%), Instagram (93.4%), and YouTube (89.5%) were the most used platforms. Daily use was 3–4 hours for 38.6% of students. Entertainment (100%), networking (78.4%), and academic learning (76.6%) were the main purposes. Unprofessional postings included clinical images (18.9%), colleague-related content (15.6%), and classroom material (8.1%). Most (94.9%) refrained from offering unsolicited medical advice. Conclusion: Social media is integral to students’ academic and social lives. While most demonstrate responsible online behaviour, lapses in digital professionalism remain. Incorporating structured training on e-professionalism into medical curricula can strengthen ethical awareness and online conduct.

Background: Identifying unknown dead bodies is an essential part of forensic medicine and plays a major role in both legal and humanitarian matters. In urban areas, where migration and homelessness are common, the number of unidentified bodies is increasing. These cases present serious challenges in terms of medicolegal procedures and public health responsibilities. Aim: To study the demographic and medico-legal profile of unidentified dead bodies at SMS Hospital, Jaipur, including cause and manner of death, seasonal trends, and identification methods. Methods: This hospital-based observational study was conducted over one year, from October 2023 to November 2024 at Mortuary Department of Forensic Medicine, S.M.S. Medical College and Hospitals. Out of 5052 total autopsies, 718 were categorized as unknown, and 120 unidentified bodies were selected for detailed analysis. Data were collected using police inquest reports, autopsy findings, and a structured proforma. The data were analysed using SPSS version 30. Observation & Results: Out of 120 unidentified bodies, 84.2% were male. Most were aged between 31 to 50 years. Respiratory failure (38.3%) was the leading cause of death, followed by head injury (20%) and haemorrhagic shock (18.3%). Natural deaths made up 49.2%, and accidental deaths accounted for 40.8%. Identifiable features like tattoos or scars were seen in only one-third of cases. DNA samples, mostly teeth, were preserved in over 90% of cases. A seasonal rise in deaths was seen during the summer. Most bodies were found in public places, and 83.3% were disposed of within two weeks of recovery. Conclusion: The study highlights the urgent need for improved identification systems, better forensic tools, and coordination between government departments. It also suggests welfare programs for vulnerable populations to reduce the number of unidentified deaths in urban areas.

Background: Domestic accidents are a rising cause of death and injury, especially in low and middle-income countries like India. Many homes are not built with safety in mind, which increases the risk of accidents. These incidents can lead to serious injuries or death, often affecting vulnerable groups like children, the elderly, and people engaged in household activities. Aim: To examine the causes and patterns of domestic accidental deaths through autopsy findings at SMS Medical College, Jaipur. Methodology: This descriptive, cross-sectional study was carried out from November 2023 to October 2024 in the Mortuary of the Department of Forensic Medicine & Toxicology, SMS Medical College, Jaipur. A total of 200 domestic accidental death cases were selected using systematic random sampling. Information was collected from inquest reports, police documents, and relatives of the deceased. A structured form was used to record details such as age, gender, accident type, time and place of occurrence, and cause of death noted during autopsy. Observation & Results: Adults made up the largest group of victims (42%), followed by elderly individuals (23%) and toddlers (18.5%). Most victims were male (60%). The leading cause of death was falling from a height (47%), followed by burns (29%) and slipping (8.5%). Most accidents occurred on Saturdays and during daytime hours, especially in the afternoon (35.5%) and morning (35%). Terraces (27%) were the most common location for fatal incidents. Shock was the most frequent medical cause of death (66.5%), followed by coma (35.5%). Conclusion: Domestic accidental deaths mainly affected adults and males, with falls and burns as the primary causes. Accidents mostly occurred during the day and on weekends. The study highlights the importance of home safety improvements, community education, and timely emergency care to reduce preventable deaths at home.

Background: The Indian Penal Code, Criminal Procedure Code, and Indian Evidence Act have now been substituted by the Bharatiya Nyaya Sanhita (BNS), Bharatiya Nagarik Suraksha Sanhita (BNSS), and Bharatiya Sakshya Adhiniyam (BSA). These legislative changes hold considerable importance for medical practitioners, especially in medicolegal contexts like cases of medical negligence and sexual offences. Objective: To evaluate the knowledge, attitude, and perception of medical professionals regarding new legal codes of Bharatiya Nyaya Sanhita (BNS) and Bharatiya Nagarik Suraksha Sanhita (BNSS). Material and Methods: A cross-sectional survey was conducted at a tertiary care medical college over six months (August 2024 – January 2025) to assess knowledge, attitude, and perception regarding BNS and BNSS. Participants included MBBS students (second year onwards), interns, postgraduates, and practising doctors. Data were collected using a validated, self- dministered online questionnaire. Out of 354 responses received, 30 were excluded for incompleteness or non-consent, yielding a final sample of 324 participants. Statistical analysis was performed using descriptive statistics, Chi-square tests, and logistic regression, with significance set at p<0.05. Results: Interns and MBBS students showed more awareness on most of the questions compared to practising doctors because of a lack of adequate continuing medical education among practising doctors and a lack of postgraduate-level training on practical legal issues. About 65% of the participants perceived that the new codes could improve the doctor-patient relationship. Conclusion: The overall positive outlook among MBBS students and interns is encouraging, but knowledge gaps in practising doctors highlight the need for additional medicolegal education and training.

Background: Fingermarks can be used to profile donors by providing details about their gender, age, lifestyle, and interaction with illegal substances. Chemical constituents in the fingermarks can reveal significant information about the fingerprint’s origin, which is particularly beneficial in situations where the donor’s identity is unclear or the print is smudged, deformed or unclear. Aim: To study the exogenous and endogenous substance present in the fingermarks of individuals with respect to their lifestyles. Material and Methods: In this study, the latent fingermarks donated by 42 individuals of Jhansi, Uttar Pradesh, India were analyzed using Gas Chromatograph Mass Spectrometry to determine the exogenous and endogenous constituents present respectively. Results: Multivariate technique of Principal Component Analysis was applied on the GC data. Further, Hierarchical Cluster Analysis and K means Cluster technique were applied on the results of PCA, to validate the results. PCA showed that the high-dimensional data could be summarized in a few principal components, with the first two components capturing over 27% of the total variance. The biplot showed that the samples are not randomly distributed but instead form discernible groups, with some samples being chemically similar and other samples being distinct outliers. K-Means clustering provided a quantitative validation by assigning each sample to one of three distinct clusters, which were consistent with the visual groupings from both the PCA and HCA plots. Conclusion: It can be effectively stated that an individual’s daily lifestyle and occupation have a significant influence on the exogenous and endogenous constituents of his finger mark. Key Message: Donor profiling using chemical constituents of fingermarks, is anticipated to become a common practice in the near future as part of the crime scene investigation.

Identification is a key aspect particularly in the cases involving decomposition, mutilation or in mass disasters. Teeth own resilience hence, serves as a reliable marker to serve as a remedy for the purpose of identification. The exploration of teeth with AI revolutionized conventional methods of identification with contemporary ones yielding automation and better accuracy. This review portrays the transformation of conventional/manual comparison procedures of dentition to AI driven architectures. Advantageous enabling of AI strengthens reproducibility, transparency and standardization. However, this review also showcases the challenges associated with teeth identification such as ethical concerns, diversity population and legal acceptance. Eventually, the convergence of computational intelligence with dentistry serves as a transformative era of tracing identity through technology

Background: Suicide among healthcare workers, particularly doctors and nurses, has emerged as a major concern both for forensic experts and public health professionals.1 The emotionally taxing nature of their roles, exposure to trauma, easy access to lethal substances, and high workload contribute to an increased risk of suicide. Aim: To explore the forensic aspects, patterns, and medico-legal implications of suicide among healthcare workers and evaluate the role of forensic investigations in identifying causes and occupational linkages. Objectives: 1. To assess the prevalence and occupational risk factors for suicide in healthcare professionals. 2. To review forensic pathology and autopsy findings in these cases. 3. To evaluate medico-legal protocols and recommend preventive strategies. Material: An integrative review of literature from PubMed, Scopus, and other indexed databases covering forensic case reports, autopsy studies, psychological autopsy data, and medico-legal investigations from 2010 to 2024. Author’ Result: The analysis indicates that suicide in healthcare professionals is underreported due to stigma and institutional concerns. Common methods include medication overdose (35%), hanging (30%), and self-poisoning (15%). Forensic investigations frequently show usage of hospital medications or familiarity with lethal procedures. Mental health histories often reveal untreated depression, burnout, or anxiety, all exacerbated by occupational pressures.2,6,7 Conclusion: Understanding the forensic and medico-legal dimensions of suicides in healthcare workers is vital for prevention and legal accountability. Forensic pathologists play a key role in establishing occupational causes, ruling out negligence or foul play, and supporting institutional reforms.3,10

Background: Snakebite envenomation is a neglected tropical disease causing substantial mortality in India, with an estimated 58,000 deaths annually, roughly half of global snakebite deaths. Important uncertainties remain regarding regional venom variation, species specific antivenom requirements, healthsystem performance, economic burden, and effective community level interventions. Objectives: To systematically evaluate, the epidemiology and geographic distribution of snakebite envenomation in India and globally; clinical features, complications, and mortality associated with major venomous species; antivenom therapy practices, efficacy, dosing, and adverse reactions; emerging innovations in snakebite management; and gaps in policy, public health response, and research priorities. Data sources: PubMed, Embase, Scopus, Web of Science, Google Scholar, and IndMed were searched from January 1990 to October 2025; reference lists of included articles and relevant reviews were also screened. Study eligibility criteria: Eligible studies were peer reviewed human research from India or neighbouring South Asian countries, including randomized and non randomized trials, cohort studies, crosssectional studies, and case series with at least 20 patients, reporting data on epidemiology, venom composition, clinical features, treatment, outcomes, costs, or community knowledge related to snakebite envenomation; single case reports, non peer reviewed opinions, and studies with unclear methods or incomplete outcome data were excluded. Study appraisal and synthesis methods: Two reviewers independently screened titles/abstracts and full texts and extracted data using a standardised form; disagreements were resolved by discussion or a third reviewer. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools appropriate to study design, with studies scoring at least 7/10 considered acceptable for quantitative synthesis. Random effects meta-analysis was used to pool treatment outcomes and mortality, heterogeneity was quantified with I², and subgroup analyses explored the effects of snake species, geographic region, and time from bite to antivenom administration; funnel plots and Egger regression were used to assess publication bias. Results: Of 1,967 records identified, 100 studies met the inclusion criteria and 85 contributed data to metaanalysis. Cobra venom potency varied approximately 3.6 fold across India (lethal dose 0.35–1.25 mg/kg), paralleling regional differences in respiratory failure from 77% in northern India to 22% in southern India. Across 1,847 patients with species confirmed bites, mean antivenom use was 8.9 ± 3.3 vials for cobras, 18.3 ± 6.8 for kraits, and 12.1 ± 4.5 for Russell’s viper, with krait bites showing markedly lower treatment success (41%) than cobras (94%). Each hour of delay from bite to antivenom administration reduced treatment success by about 3.2 percentage points, and national economic losses were estimated at `45–120 billion annually when direct and indirect costs were combined. Misidentification of snake species occurred in 20–30% of cases and was associated with about 2.5% absolute excess mortality due to inappropriate dosing, while emerging recombinant antivenoms and monoclonal antibodies remain at least 10–15 years away from widespread clinical use. Limitations: Most evidence came from retrospective hospital based studies in a limited number of high burden states, with sparse data from Northeast and Central India, limited longterm disability outcomes, and heterogeneity in outcome definitions and economic methods. Conclusions: Snakebite mortality in India is driven less by venom potency than by modifiable healthsystem and community factors, including delayed access to antivenom, non species specific dosing, and frequent misidentification of biting species. Immediate priorities are region and species specific treatment protocols, reliable antivenom supply at first contact facilities, and scalable training for village health workers and clinicians, while future research should refine regional venom characterization, update economic estimates, and evaluate digital and communitybased interventions. Registration: PROSPERO CRD420251168454

Introduction: Non-Hodgkin’s lymphoma (NHL) comprises many hematologic malignancies presenting commonly as an intrathoracic or mediastinal mass. Case Report: Here we report a case of sudden death in a 7-year-old girl resulting from NHL diagnosed after autopsy. The disease had extensive extra nodal involvement, including the heart; however, the child was surprisingly asymptomatic. Conclusion: The prognosis of children diagnosed with NHL is reported as very good, even in those with advanced disease, but a delay in presentation of the disease led to a delay in diagnosis and treatment in this case.